Persistent proteinuria

Introduction Persistent urinary protein is mostly pathological urinary protein, which means that urinary protein is not affected by receptor position, and urine protein is positive for multiple times. urinary protein quantification and composition analysis should be carried out, and further differentiated by clinical combination. Usually when the kidney spheroid or tubular irreversible damage occurs, there will be persistent proteinuria. Glomerular disease is the most common cause of pathological proteinuria. In addition, the common kidney disease caused by diabetes is called diabetic nephropathy. Most patients who are affected by diabetes and cause kidney disease will expel proteinuria; even if only a small amount of protein is excreted every day, the patient's kidneys have been affected by diabetes and may be more severely damaged in the future, so when diabetics find themselves with trace amounts of When proteinuria, you should seek treatment as soon as possible in order to receive appropriate treatment.

Cause

1. Glomerular urinary protein

1 primary glomerular disease;

2 secondary glomerular diseases, such as lupus nephritis, diabetic nephropathy, renal amyloidosis, etc.;

3 hereditary nephritis.

Second, renal tubular protein

1 chronic pyelonephritis (reflux renal disease);

2 chronic interstitial nephritis of unknown origin;

3 renal tubular disease caused by antibiotics;

4 painkillers kidney disease;

5 gouty kidney disease and so on.

In summary, the common causes of persistent urinary protein are diverse, so it is necessary to pay special attention to find out the source of the disease.

an examination

According to the different mechanism of urinary protein, it can be mainly divided into glomerular urinary protein and renal tubular protein.

1. Glomerular urinary protein

Urine protein can vary from mild to severe. If the urine protein exceeds 3.5g/d, it is undoubtedly glomerular urine protein.

Second, renal tubular protein

Its urine protein is generally less than 1g / d, mainly small protein.

Primary glomerular disease: including acute glomerulonephritis (acute nephritis), chronic glomerulonephritis.

Secondary glomerular disease: A glomerular disease caused by other diseases of the body, called secondary glomerular disease, such as lupus erythematosus, kidney disease caused by scleroderma.

Urinary protein in children with persistent benign urinary protein has no relationship with body position, that is, excessive amounts of urine protein can be excreted in both upright and supine positions, but can also be exacerbated in the upright position. There are generally no other symptoms, and erythrocyte sedimentation rate, blood chemistry, renal function, and renal histology are all within the normal range. In the census, such children can account for 5% to 10% of children with asymptomatic urinary protein.

In addition, the common kidney disease caused by diabetes is called diabetic nephropathy. Most patients who are affected by diabetes and cause kidney disease will expel proteinuria; even if only a small amount of protein is excreted every day, the patient's kidneys have been affected by diabetes and may be more severely damaged in the future, so when diabetics find themselves with trace amounts of When proteinuria, you should seek treatment as soon as possible in order to receive appropriate treatment.

Differential diagnosis

(1) Temporary proteinuria: When the patient has dehydration, fever, too cold weather, intense exercise, taking painkillers, or high fever, acute illness, pregnancy, high blood pressure, etc., transient proteinuria may occur.

(2) Postural proteinuria: closely related to the change in the position of the patient's body. Postural proteinuria is often found in young people. In general, patients lack protein in the morning, but after a long period of activity, walking, strenuous exercise, standing, or flexion, proteinuria will appear. When the patient is lying down, the measurement will disappear. In general, patients younger than 30 years old, urine protein is less than 2 grams per day, and Ccr (creatinine clearance rate) is normal, as long as regular blood pressure is measured and tracked annually; if it is greater than 30 years old, regular blood pressure is required, every six Check urine and kidney function for months.

(3) Intermittent proteinuria: Repeated infection of cystitis, pyelonephritis, urine protein, once the infection is controlled, proteinuria will disappear; and high blood pressure, heart failure and other diseases will appear intermittently with the disease Sexual urine eggs.

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